Can an NP’s Supervising Physician Protect the NP from the BRN?
By Melanie Balestra, NP, Esq.
Most nurse practitioners believe that if their physician agrees with their care of the patient and signs their standard procedures, they are protected from complaints from the Board of Registered Nursing. This is simply not true.
In recent cases that I have been involved, the supervising/collaborating physician has agreed with the care that the NP has given the patient, and the NP has consulted with the physician appropriately. However, the BRN ruled that the NP did not meet the nursing standard of care. It does not matter that the NP met the medical standard of care.
The nursing board has jurisdiction over RNs and NPs, and appears to recognize nursing care, not medical care. Although NPs cannot practice independently in California and have to practice under a supervising physician, the BRN frequently does not recognize the supervising physician’s opinion or support of NP care. This makes it very difficult for the NP’s defense in a disciplinary case. The BRN is ultimately deciding that the physician’s decision was wrong, which is not under their purview.
I have been involved in several cases where there is dual certification as a PA and NP. The BRN placed the NP on probation and the PA Board dismissed the case. There is definitely something wrong with this picture. Medical care is medical care, and the standard of medical care is across the line. Nurse practitioners, physician assistants and physicians are not all under different medical standards of care. Therefore, this raises the question of whether the BRN truly does not understand the medical care that NPs are educated and trained to give.
Under the Medical Board, physician assistants have their own governing board. Why don’t Advanced Care Practitioners have their own board? A board consisting of Advanced Care Practitioners would be able to evaluate and understand standards of care for nurse practitioners better than a board with only one NP.
We have fought long and hard to remain under the Board of Registered Nursing. In most states, NPs are regulated under the boards of nursing. However, while physician assistants under their own board go forward in California, nurse practitioners appear to be at a standstill.
The moral of this story is to be very careful in your practice to meet BRN standards of care. Although you definitely want your physician’s support, their opinion cannot protect you from BRN discipline.
Melanie Balestra is both an attorney and a nurse practitioner. She is a former President of CANP, and is currently President of the American Association of Nurse Attorneys, which in 2016 honored her with the award for Outstanding Health Law & Compliance Section Member. She has law offices in Irvine and Newport Beach, and continues to work part time as a PNP and Director of Pediatrics at the Laguna Beach Community Clinic.